• Ananth Mahes, Zachary A Macchi, Christine S Martin, Maya Katz, Nicholas B Galifianakis, Steven Z Pantilat, Jean S Kutner, Stefan Sillau, and Benzi M Kluger.
• Weill Institute for Neurosciences (A.M., N.B.G.), University of California San Francisco, San Francisco, California. Electronic address: ananth.mahes@ucsf.edu.
• J Pain Symptom Manage. 2024 Jan 1; 67 (1): e1e7e1-e7.

ContextParkinson's disease and related disorders (PDRD) are fatal neurodegenerative disorders characterized by a fluctuating course that can complicate prognostication. The "surprise question" (SQ: "Would you be surprised if your patient died in the next year?") has been used to identify patients with limited prognosis but has not been assessed in PDRD.ObjectivesTo determine the validity of the SQ in predicting 12-month mortality in PDRD.MethodsData was analyzed from 301 patients and 34 community-based neurologists who were participating in a clinical trial of outpatient palliative care for patients with PDRD. Clinicians answered the SQ for each patient at baseline. Descriptive statistics at baseline, chi-square tests of independence, 2 × 2 and 2 × 3 cross tables were used. Survival analysis compared SQ responses using Kaplan-Meier curves. Risk estimate analyses identified patient characteristics associated with clinicians' responses.ResultsMortality was 10.3% (N = 31) at 1 year. The sensitivity and specificity of the SQ was 80.7% and 58.9%, respectively with AUC = 0.70, positive predictive value of 18.4% and negative predictive value of 96.4%. Older age, atypical parkinsonism, and dementia were associated with responding "no" to the SQ.ConclusionThe SQ is sensitive to 12-month mortality in PDRD, with a high negative predictive value. The SQ may be useful for identifying patients less likely to die within a year and may be useful for identifying patients with palliative care needs outside of end-of-life care. This latter use may assist in mobilizing early and timely referral to specialist palliative care.Copyright © 2023 American Academy of Hospice and Palliative Medicine. All rights reserved.

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